Use of Tourniquets in Mass Casualty Incidents and “Stop the Bleed” Program

The use of tourniquets, as a temporary procedure to control extremity bleeding, may be life saving. For many years, the use of tourniquets was banned from civilian prehospital protocols for management of limb hemorrhage due to concerns for complications, mainly loss of limbs. Military studies published by the Israeli, Americans, and British in the past 15 years, show that tourniquets are effective to control bleeding in the battlefield, are associated with minor complications and no limb loss. These outcomes were replicated in civilian studies as well. Recently, the advanced trauma life support (ATLS®) course introduced tourniquet use as an alternative for management of limb hemorrhage, when direct pressure fails to control bleeding. Nevertheless, in some situations when improvised tourniquets (cloths, ropes, ties) are applied by untrained bystanders, the opposite effect may occur, and the bleeding may increase. Therefore, tourniquet application should be limited to trained personnel. Untrained bystanders should be allowed to hold pressure directly on the bleeding site until trained personnel arrive. The “Stop the Bleed” training program, recently introduced by the American College of Surgeons (ACS), should increase the number of bystanders trained to control the bleeding until EMS arrives.